Evaluating the impact of intubation pillow on laryngoscopy grade in children: A Randomized controlled trial

Laryngoscopy and intubation remain critical in pediatric patients as compared to adult patients due to different anatomy. This study was conducted to compare the Cormack and Lehane grade (CL) of laryngoscopy, percentage of glottic opening (POGO) score, and the efficacy of backward upward rightward pressure (BURP) maneuver to improve laryngoscopy grade with or without the use of intubation pillow. A randomized controlled trial was done from January 2020 to July 2020 on 68 children with 34 children in Group 1 (with intubation pillow) and 34 patients in Group 2 (without intubation pillow). Children between 5 and 12 years of age (the American Society of Anesthesiologists class I and II) planned for surgery under general anesthesia with endotracheal tube were included in this study. Pillow of 4 cm size was used in 5–9 years and 6 cm pillow in 9–12 years of age group. Macintosh laryngoscope was used for intubation. CL grading and POGO score were assessed. BURP maneuver was given in cases of difficult laryngoscopy of CL grade above 2 and its effect on improvement in CL grading was measured. Group 1 children had significantly more CL grade I (83.3% vs. 16.7%); significantly lesser CL Grade IIb (23.1% vs. 76.9%, P = 0.001); and significantly more POGO score (97% vs. 86%, P < 0.05) than Group 2. The use of BURP maneuver significantly improved the laryngoscopy view in both the groups. The use of intubation pillow in children between 5 and 12 years of age facilitated better laryngoscopy view and POGO score.